Provider Demographics
NPI:1598728313
Name:COHEN, HAL (DO)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9422
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-9180
Practice Address - Street 1:1 GRANNY SMITH CT
Practice Address - Street 2:
Practice Address - City:OLD ORCHARD BEACH
Practice Address - State:ME
Practice Address - Zip Code:04064-1471
Practice Address - Country:US
Practice Address - Phone:207-934-7276
Practice Address - Fax:207-934-0465
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME311530099Medicaid
ME2241696OtherAETNA
MEE86724OtherHARVARD PILGRIM
MEM10001501OtherCIGNA
ME017221OtherANTHEM
MEE86724OtherHARVARD PILGRIM
MEMM3752Medicare ID - Type Unspecified
MEMM375201Medicare PIN